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Erection Problems (Erectile Dysfunction)

Topic Overview

What are erection problems?

A man has erection
problems if he cannot get or keep an erection that is firm enough for him to
have sex. Erection problems are also called erectile dysfunction or
impotence.

Most men have erection problems every now and then. This is normal. These problems can occur at any age. But they are more common in older men, who often have other health problems. Treatment can help both older and younger men.

What are the symptoms?

The only symptom of an
erection problem is being unable to get and keep an erection that is firm
enough to have sex. But even with an erection problem, a man may still have
sexual desire and be able to have an orgasm and to ejaculate.

How are erection problems diagnosed?

Your doctor
can find out if you have an erection problem by asking questions about your
health and doing a physical exam. Your doctor will want to know how often the problem
happens. The exam, lab tests, and
sometimes mental health tests can help find out the cause of the
problem.

How are they treated?

Doctors usually start with lifestyle changes
and medicines. They usually don't advise surgery or other treatments unless
those first steps don't help.

Treatment can include:

Avoiding
tobacco and drugs and limiting alcohol.

Talking about the issue with your
partner, doing sensual exercises, and getting counseling.

Finding and
then stopping medicines that may be causing the problem. In some cases you can
take a different medicine that doesn't cause erection problems.

Taking prescription medicine that can help you get erections. These include
pills such as sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil
(for example, Levitra). Check with your doctor to see if it is safe for you to take one of
these medicines with your other medicines. These pills can be dangerous if you have
heart disease that requires you to take nitroglycerin or other medicines that
contain nitrates.

Taking medicines and getting counseling for
depression or anxiety.

Using vacuum devices or getting shots of
medicine into the penis.

Having surgery to place an implant in the
penis.

Can you prevent erection problems?

Erection problems are most often caused by a physical problem. So it's important
to eat healthy foods and get enough exercise to help you stay in good
health.

To reduce your risk of having an erection problem, don't
smoke, drink too much alcohol, or use illegal drugs.

You may be
able to avoid erection problems related to anxiety and stress by talking with
your partner about your concerns. This may help you relax.

Physical problems

Physical problems cause about 8 out of 10 cases of erectile dysfunction. Physical problems are often the cause of
erection problems in men age 50 or older. They include:

Side effects of medicines, including some medicines for high blood pressure or
depression. In some
cases it may be possible to change the dose of the medicine or to use another
medicine. Talk to your doctor.

The use of tobacco, alcohol, or illegal drugs. Stopping or reducing the use of these substances may make the erection problem less severe.

Problems with the blood vessels. These problems may prevent blood from filling the penis or from staying
there long enough to maintain an erection. For example, long-term
high blood pressure can cause damage to blood vessels
and lead to erection problems.

Problems with the nerves (neurologic
problems). These may prevent arousal signals from traveling from the brain and spinal
cord to the penis.

These things interfere with the erection process by distracting the man from things
that would normally arouse him.

Erection problems in men younger than 40 who
have no physical risk factors are more likely to be caused by mental factors than physical causes.

Symptoms

Symptoms of
erection problems include being
unable to:

Have an erection, most of the time.

Keep an erection firm
enough for sexual intercourse.

Keep an erection long enough to
complete sexual intercourse.

Even with an erection problem, a man may still have sexual
desire and be able to have an orgasm and to ejaculate.

What Happens

Most men have erection problems now and then. But when
erection problems are lasting, they can affect your self-image, sex life,
and relationship. When you have erection problems often, "performance
anxiety" can make the problem worse. If you cannot keep an erection that is
firm enough for intercourse, or if you have an orgasm before or right after
entering your partner (premature ejaculation), you may feel
frustrated and believe you aren't pleasing your partner. All of these things
could affect how you view your relationship.

Fortunately, many
of the things that cause erection problems can be treated.

What Increases Your Risk

Your risk of having an
erection problem increases with
age. Other things that increase your risk include:

Diseases that affect blood vessels, such as diabetes, high blood pressure, and high cholesterol. About
half of men with diabetes develop erection problems.

Diseases that affect nerves. These include multiple sclerosis and Parkinson's disease.

Injuries to the pelvic area, a spinal cord injury, or treatment
such as pelvic surgery or radiation in the pelvic area.

Using substances, such as long-term (chronic) alcohol abuse.

Psychological risk factors,
such as depression or a recent life
change.

Activities that constrict blood flow to the penis may increase the risk for erection problems. For example, frequent long-distance bicycle riding on a hard, narrow saddle may increase risk. But the possible link between bike riding and erection
problems has not been proved. Experts continue to debate
this issue.

A
vasectomy usually doesn't cause erection problems.
But pain after the operation may affect sexual performance for a time. And if a
man wasn't comfortable with his decision to have a vasectomy, or if he's having
second thoughts, it could affect him psychologically.

When To Call a Doctor

Call your doctor now or seek medical care right away if:

You have an erection that lasts longer than 3 hours.

You have taken sildenafil (for example, Viagra) or vardenafil (for example, Levitra) in the past 24 hours or tadalafil (for example, Cialis) in the past 48 hours, and you have chest pain. Do not take nitroglycerin. Make sure all the doctors you see know that you took one of these medicines.

You have erection problems that occur along with pain or difficulty with urination, fever, or pain in the lower belly.

Call a doctor if erection problems occur:

With any type of injury to the back, legs, buttocks, groin, penis, or testicles.

With other symptoms such as loss of hair, enlargement of the breasts, or backache.

With any change to the medicine you take.

If your erection problem happens just now and then, there is no reason
to call your doctor. If it happens often and upsets you or your partner, it is okay to call your doctor. If an erection problem doesn't bother
you or your partner, you may choose not to call your doctor.

Watchful waiting

Watchful waiting means a "wait-and-see"
approach. A single episode of an erection problem is often a temporary problem that is easy to reverse. Don't assume it will happen again. Try to
forget about it, and expect a more successful experience the next time. If you
or your partner is concerned about it, talk about the problem. Openly
discuss your fears and anxieties.

If self-care has not helped
after 2 weeks and you are concerned about your erection problem,
see a doctor who has experience in dealing with these
problems.

Who to see

The following health professionals can evaluate symptoms of erection
problems:

At this point, pills such as
sildenafil (for example, Viagra), tadalafil (for example, Cialis), and vardenafil (for example, Levitra) are often recommended unless an easily treated cause (such as
a medicine side effect or testosterone deficiency) has been identified.

If pills don't work or if your doctor feels more testing is needed, he or she
may recommend:

Taking medicines safely

PDE-5 inhibitors have relatively few side effects. But they can be dangerous in certain men. If you are taking
nitrate-containing medicines, such as nitroglycerin,
you cannot use sildenafil (for example, Viagra), tadalafil (for example, Cialis), or vardenafil
(for example, Levitra).

You also should not take certain alpha-blockers—used to lower blood
pressure and to treat an enlarged
prostate gland—with these medicines. There is a
risk of a dangerous drop in blood pressure. Check with your doctor
to see whether you can take PDE-5 inhibitors with your alpha-blocker.

What to think about

Oral medicines are commonly tried first before other medicine or surgery.

It is important to involve your
partner in your decision, regardless of the treatment you choose.

Many men
overestimate how important being able to have erections is to their
relationships. Some men find that when they are able to have erections again,
the hassle of using the treatment isn't worth the effort. Other men may find
that being able to have erections doesn't change their relationship as much as
they or their partners had expected.

Prevention

You may be able to avoid
erection problems related to
anxiety and stress by taking a more relaxed approach to sex. Talk to
your partner about your problems and concerns. Sexual intimacy is a form of
communication. If you and your partner talk about sex, it will help
reduce your stress and anxiety. And you may become more relaxed.

Erections may gradually become more difficult to get and keep as you
get older. But foreplay—erotic stimulation before intercourse—and the right
environment can help increase your ability to have an erection, regardless of
your age.

Here are some other things you can do that may reduce your risk for erection problems:

Quit smoking.

Avoid using illegal drugs.

Limit alcohol. Even small amounts of alcohol can cause erection problems.

Manage high blood pressure and high cholesterol. This can help lower your risk of hardening
of the arteries (atherosclerosis).

Keep your blood
sugar in your target range if you have
diabetes.

Exercise
regularly.

Lose weight, especially if you are obese.

Lower stress in your life.

Home Treatment

In some cases, occasional
episodes of
erection problems can be treated at home,
without a doctor's help. But do involve your partner in the
process. And don't be embarrassed about seeking professional help if erection
problems are consistent and troublesome. You may be able to help yourself
by:

Some men may try methods available in health food stores or
through magazine ads. Most of these methods have never been
medically proved to work. They may be unsafe, and they are often expensive. They are not
recommended.

Making lifestyle changes such as quitting smoking and drinking less alcohol can also help make erection problems less likely. To learn more, see Prevention.

Medications

Medicines that can help produce an
erection may be used to treat
erection problems that are
caused by blood vessel (vascular), hormonal, nervous system, or psychological
problems. They also may be used along with counseling to treat erection
problems that have psychological causes.

What to think about

Although oral medicines for erection problems can
be purchased over the Internet, you need to talk with your doctor before using this medicine. This is especially important if you
have a heart problem.

PDE-5 inhibitors and heart problems

PDE-5 inhibitors should never
be used if you may need to take a
nitrate-containing medicine, such as nitroglycerin.
Taking nitroglycerin and a PDE-5 inhibitor within 24 hours of each other may
greatly lower your blood pressure. This could lead to a heart attack,
stroke, or death.

Talk with your doctor about whether medicines for erection problems are safe for you if you:

Have heart disease.

Have heart failure or low blood pressure.

Are taking drugs for high blood pressure.

If you are taking a
PDE-5 inhibitor and are going to have a test for heart disease, make sure that your
doctor knows you are taking it. You should not take sildenafil (for example, Viagra) or
vardenafil (for example, Levitra) for 24 hours before the test. Do not take tadalafil
(for example, Cialis) for at least 48 hours before the test. Then if you have a problem
during the test, it will be safe to use nitrate-containing medicines such as
nitroglycerin.

If you are using a combination of drugs for
high blood pressure, PDE-5 inhibitors could cause low blood pressure
(hypotension). Also for this reason, you should not take alpha blockers—used to
lower blood pressure and to treat an enlarged prostate—with these medicines
without talking to your doctor. The combination could cause a
dangerous drop in blood pressure.

Sex when you have heart problems

Sexual activity is exercise. If you have a heart
condition and have not been sexually active for a while, talk with your doctor to make sure you can engage in sexual activity safely.

Surgery

In a few cases, surgery may be an option to
treat
erection problems. Surgery will
rarely be recommended before nonsurgical treatment and counseling have been
tried.

Surgery choices

What to think about

Think carefully about
nonsurgical options and about the possible risks of surgery. Include your partner
in your decision.

Doctors who specialize in conditions of the
urinary tract (urologists) do most penile implants. Specially trained
urologic surgeons usually do blood vessel repair surgery.

Other Treatment

Other treatment choices

Vacuum devices are useful for all types
of erection problems—physical, psychological, or both. The device has a tube
you place around the penis. You pump the device to create a vacuum that leads
to an erection.

Counseling (psychotherapy) is recommended for men whose erection
problems are caused, at least in part, by psychological factors. Treatment may
include:

Sex therapy. It focuses on ways to improve attitudes toward sex. It also focuses on
specific sexual techniques.

Group therapy. Evidence shows that group therapy helps with erection problems
in some men. Adding group therapy to treatment with sildenafil (for example, Viagra) helped
more than sildenafil alone. Men who were taking part in group therapy also were
more likely to keep taking their medicine.1

Counseling also may be used with medicine treatment or vacuum devices for erection problems that have psychological and
physical causes.

Medicines are usually the main treatment for
erection problems. But some men try
complementary therapies. If you don't want to use
medicine, or if medicine doesn't work for you, you may want to talk with your
doctor about some of the following options. Most of these treatments need more
research before doctors can know if they work for sure.2 Treatments include:

Ginseng. It has been shown to
work for some men who have erection problems. But because it is sold as a dietary
supplement, it is hard to know if you are getting the right
amount.

The amino acid L-arginine. Some men take this dietary
supplement to try to treat erection problems. The amino acid increases the
amount of nitric oxide in the blood, which relaxes blood vessels. In theory,
L-arginine could improve erections. But L-arginine may be harmful.

Zinc. Some
men who have low zinc levels in their body have had success using zinc
supplements to treat erection problems. But high doses of zinc can be
dangerous.

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